Information Collection Request

Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

ICR 201810-0938-007 · OMB 0938-1314 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10621 414.1330 (Quality Performance Category) Call for Measures Form and Instruction Modified Available
Form CMS-10621 414.1375 Advancing Care Information Performance Category - Call for Measures Form and Instruction Modified Available
Form CMS-10621 ?414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process Form and Instruction Modified Repair queued
Form CMS-10621 ?414.1360 (Improvement Activities Performance Category) Call for Activities Form Modified Available
CMS-10621 - Supporting Statement A (version 1 by OSORA PRA).docx Supporting Statement A Uploaded 2018-10-17 Available
CMS-10621 MIPS CY 2019 Supporting Statement B NPRM (06-29-18).docx Supporting Statement B Uploaded 2018-10-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
233582 ?414.1440 Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option New
233581 ?414.1325 and 414.1335 CMS Quality Payment Program Identity Management Application Process New
229086 414.1330 (Quality Performance Category) Call for Measures Form and Instruction Modified
229075 414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process Modified
229074 414.1375 Advancing Care Information Performance Category - Call for Measures Form and Instruction Modified
227511 ?414.1395 (Physician Compare) Opt Out for Voluntary Participants Modified
227509 ?414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process Form and Instruction Modified
227507 ?414.1360 (Improvement Activities Performance Category) Call for Activities Form Modified
227506 ?414.1375 (Advancing Care Information Performance Category) Significant Hardships, including for small practices and decertification of EHRs Modified
227505 ?414.1330 and §414.1335 Quality Performance Category) Registration and Enrollment for CMS Web Interface Modified
221786 $414.1430 (Partial Qualifying APM Participant (QP) election) Modified
221785 ?414.1360 (Improvement Activities) Modified
221784 ?414.1375 (Advancing Care Information Performance Category) Modified
221782 ?414.1400 QCDR and qualified registry self nomination Modified
221781 ?414.1330 and §414.1335 CMS Web Interface Submission Mechanism Instruction Modified
221780 ?414.1330 and §414.1335 EHR Submission Mechanism Modified
221779 ?414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Modified
221777 ?414.1330 and §414.1335 Claims Submission Mechanism Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2020 36 Months From Approved 03/31/2020
1,161,681 0 1,161,681
7,559,375 0 7,559,375
0 0 0





Reginfo record details
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table that charts list of burden
IC Title Form No. Form Name
§414.1330 and §414.1335 Claims Submission Mechanism
§414.1330 and §414.1335 EHR Submission Mechanism
§414.1330 and §414.1335 CMS Web Interface Submission Mechanism
§414.1400 QCDR and qualified registry self nomination
§414.1375 (Advancing Care Information Performance Category)
§414.1360 (Improvement Activities)
$414.1430 (Partial Qualifying APM Participant (QP) election)
§414.1375 (Advancing Care Information Performance Category) Significant Hardships, including for small practices and decertification of EHRs
§414.1395 (Physician Compare) Opt Out for Voluntary Participants
414.1330 (Quality Performance Category) Call for Measures CMS-10621 Data Template for Candidate Measures
414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process
§414.1325 and 414.1335 CMS Quality Payment Program Identity Management Application Process
§414.1440 Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option
414.1375 Advancing Care Information Performance Category - Call for Measures CMS-10621, CMS-10621 Promoting Interoperability Performance Category (Call for Measures Submission Form) ,   ACI Call for Measures Submission Form
§414.1330 and §414.1335 Quality Performance Category) Registration and Enrollment for CMS Web Interface
§414.1360 (Improvement Activities Performance Category) Call for Activities CMS-10621 Improvement Activities Performance Category (Call for Activities Submission Form)
§414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process CMS-10621, CMS-10621 Clinician Initiated Submission Form ,   Payer Initiated Submission Form
§414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism



Reginfo record details
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